Attachment Theory and Treating Narcissism

There is a tonne of peer reviewed research evidence which demonstrates the link between the development of narcissistic personality disorder and the parenting narcissists received as children. The combination of vulnerability and grandiose exhibitionism and a hunger for attention stem, we are told, from a lack of appropriate attention from a sensitive care giver when they were tiny babies. This “abusive” parental treatment often continued throughout childhood where parents controlled, exhibited or undermined their growing child, leading to NPD in adults who were vulnerable as children.

Narcissistic Personality Disorder is particularly difficult to treat the first obstacle usually being that the narcissist themselves will fail to see that they have a problem but secondly, should they want to change, standard therapeutic programmes such as the very fashionable cognitive behaviour therapy, fail to bring about lasting change. Dropout rates due to breakdown in the therapeutic relationship are also an issue since narcissists often quickly move from believing their therapist is the best in the world to denigrating them completely. Understanding and applying attachment theory to therapy might help.

What is Attachment?

British psychiatrist John Bowlby based at The Tavistock in London spent his life researching children with disruptive behaviours. The culmination of his many years’ work was that it was the relationship between the baby and its primary care giver in early infancy which was the key to a stable adult personality.

His view was that such a need was biologically programmed into a child’s developing brain. When they cried then needed comfort. When they smiled they needed someone to smile back and these reciprocal relationships were the key and needed to be consistent for the child to develop what he called an internal working model of how relationships worked. With inconsistent or unresponsive parenting, a child would not develop a secure sense of self and would fail to form strong or enduring adult relationships.

As a further dimension of attachment, as a child grows it also needs to be presented with appropriate challenges by a trusted adult to enable it to grow in confidence and stamina. If these are harsh, or the child is judged negatively for failure this can also affect self-esteem and create trust issues.

Mary Ainsworth, a student of Bowlby devised an experiment which tried to assess the quality of this parental-child bond. She named this experiment “The Strange Situation” because it involved putting toddlers in an unusual situation where their carers left them with a stranger and recording their reaction. She noted that a significant minority of infants didn’t have a healthy attachment.

Infants were classified as being securely attached or insecurely attached. Now, whilst not all children with insecure attachment go on to develop personality disorders, Bennet (2006) reviewed students which suggested that insecure attachment was a precursor of many styles of disorders in social relations. She quoted research which concluded:

“There are behavioral, emotional, and physiological implications of attachment security’ in infancy for future development”

And whilst this can be observed in Narcissists it is suggested that the vulnerabilities are also in other disordered mental states too. These basic “deficits” are linked to a lack of a clear understanding of oneself and identity combined with limitations in how to inter-relate with others.

Therapeutic success is hard to achieve because Narcissists are vulnerable to wounding and the process of therapy, by its very nature involves unpacking and challenging painful thoughts, memories and deeds.

Approaching therapy with narcissists

Successful attachment therapy for children with attachment disorders often includes an element which allows a child to regress to a safe infant state where they can learn to explore. Bennet suggests that “Ideally, the therapist follows the lead of the patient, akin to an autonomous parent attuned to the needs of her securely attached child. When the patient feels secure enough to explore the internal or external world, the therapist facilitates this process; when the patient sends cues of stress and a need for comfort, the therapist provides help in organizing and regulating the feelings, cognitions, and effects of the patient.”

Unlike the constant challenge presented in CBT ideas about change are explored only when the patient feels secure. If anxiety or proximity need is triggered, the process is stopped to enable re-connection.

This ongoing, reciprocal, and circular process is founded on recognition that the attachment and exploratory systems are intricately linked— successful exploration occurs when the patient experiences a sense of security, and the patient returns to the safe haven of the relationship when anxiety or fear triggers a need for proximity.

This may be the breakthrough in treatment which is needed for pathological narcissism which is notoriously difficult to treat. As Bennet suggests:

“Even patients with pathological narcissism can change their relational patterns through the relationship with a secure and sensitive therapist.”

Caution is needed however, as with other personality disorders there is no panacea and while working in a manner which is acknowledges the attachment issues must be helpful, it does not constitute a treatment programme. It does however shed light on the need to treat the root causes of Narcissism and the vulnerabilities rather than magnifying the character deficits and faulty thinking.

The downside of this approach is that it takes a long time to develop a trusting therapeutic relationship, and progress may be both halting and slow. It also does not prescribe a route to mental health. Both of these issues, time and lack of defined benefit make this mode of treatment an unattractive option for those who may have to foot the bill – either the individual, insurance company or the state. But what is cost when set against ending suffering not least for the people who suffer narcissistic behaviours from a family member or even the narcissist themselves?

Bennet, S. (2005): Attachment Theory and Research Applied to the Conceptualisation and treatment of Pathological Narcissism. Social Work Journal March 2006